Capsulectomy Surgery: Everything You Need to Know

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A capsulectomy is the surgical removal of abnormally thick, hardened tissue that forms around breast implants—a condition known as capsular contracture. Your breast implant is removed and usually replaced during the procedure.

Surgeon holding a breast implant


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A capsule is the protective, fibrous tissue that your body forms around any object introduced to and left in the body. In the case of breast implants, the capsule also helps keep them in place.

But with capsular contracture, the capsule tightens and the tissue becomes abnormally dense, causing breast pain and distortion. A capsulectomy aims to address both of these issues.

Aside from capsular contracture after breast augmentation or breast reconstruction, a capsulectomy may also be done for other reasons, such as when breast implants are removed due to an implant or capsule infection, rupture, or cancer.

By reading about what this surgery entails, from start to finish, you will hopefully feel more prepared and at ease going into a discussion with your surgeon about this operation.

What Is a Capsulectomy?

With a capsulectomy, a plastic surgeon removes the scar tissue that forms around a breast implant. The implant itself is also usually replaced.

There are two main types of capsulectomies:

  • Subtotal or partial capsulectomy: Surgical removal of some but not all of the capsule
  • Total or complete capsulectomy: Surgical removal of the whole capsule (taken in sections) surrounding the breast implant

A third type of capsulectomy—en bloc capsulectomy—entails surgical removal of the capsule and the implant as one intact unit. This technique is higher-risk, more complicated, and reserved for very select cases—most notably, patients with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

In cases where capsular contracture continues to be a problem, or if a patient does not desire an implant replacement, autologous tissue reconstruction may be offered. With this surgery, the breast is reconstructed using a flap of tissue taken from the patient's abdomen, back, buttocks, or thigh.

Since your body will not create a capsule around a flap, autologous breast reconstruction removes the risk of capsular contracture from re-developing.

Capsulectomy vs. Capsulotomy

A capsulotomy is a similar-sounding, though different type of surgery that may be used to treat capsular contracture.

During a capsulotomy, the capsule is cut open and "released," so that it is not squeezing the implant so tightly.

Capsulectomy and capsulotomy are the only proven treatment options for capsular contracture. However, capsulectomy is considered the gold-standard treatment option.

Capsulectomy
  • More invasive; removes capsule and implant

  • More technically challenging/takes longer to perform

  • Greater risk for nerve damage

Capsulotomy
  • Involves tissue release, not removal

  • Implant stays in place

  • Initially effective, but capsular contraction tends to recur

Disqualifications and Considerations

You should not have a capsulectomy if you:

  • Have untreated breast cancer or pre-cancerous breast disease
  • Have an active infection anywhere in the body
  • Are pregnant or breastfeeding

A capsulectomy should be done with caution in people with a:

  • Weakened immune system
  • Bleeding disorder
  • History of prior surgery or radiation that impairs blood flow to the breast tissue

If any of these apply to you, mention them to your healthcare provider and discuss whether or not the pros of capsulectomy outweigh the cons in your case.

Potential Risks

In addition to the risks of anesthesia and general risks of surgery (e.g., bleeding, infection, etc.), specific risks associated with a capsulectomy include:

  • Breast implant failure, contamination, damage, displacement, rotation, or extrusion through the skin
  • Recurrence of capsular contracture
  • Chest wall irregularities
  • Change in nipple sensation
  • Skin changes (e.g., contour and shape irregularities, visible and palpable wrinkling, or increased sensitivity)
  • Poor wound healing
  • Damage to nearby blood vessels, nerves, or organs (e.g., lungs)
  • Breast fat necrosis (tissue death)
  • Breast seroma (fluid pocket)
  • Unsatisfactory results

Purpose

The primary purpose of a capsulectomy is to treat capsular contracture.

Experts suspect capsular contracture is an extreme foreign body reaction to a breast implant. Collagen is produced from the inflammation that ensues, causing tissue to become more fibrous. Breasts become extremely firm and painful as a result.

This complication may occur soon after surgery or years later. It may affect one or both breasts.

There are four grades of capsular contracture, referred to as Baker Grades 1 through 4:

  • Grade 1: The breast is normally soft and appears natural.
  • Grade 2: The breast is slightly firm but still appears natural-looking.
  • Grade 3: The breast is firm, hard-to-the-touch, and appears distorted.
  • Grade 4: The breasts are hard, painful, and distorted.

To correct the capsular contracture, a capsulotomy or capsulectomy with possible replacement of the implant is often required, especially for grade 3 and grade 4 contractures.

Other Uses

Besides capsular contracture, other indications for a capsulectomy include:

  • Ruptured silicone gel implants: When a tear or hole in an implant's outer silicone shell develops, allowing for the gel to leak out
  • Capsule infection: When the area around the capsule becomes infected
  • Implant extrusion: When an implant protrudes through the skin
  • Breast implant illness: A condition that causes a wide range of symptoms (e.g., fatigue, malaise, muscle aches) and may occur after breast augmentation or reconstruction with implants
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): A very rare type of cancer that develops in the scar capsule surrounding a breast implant

Getting Cleared for Surgery

When a capsulectomy is scheduled, various pre-operative tests for medical and anesthesia clearance need to be run.

Such tests often include:

You may also be asked to undergo a mammogram if you are over age 40 or at high risk for breast cancer.

In some cases, imaging tests like a breast ultrasound or breast magnetic resonance imaging (MRI) may also be ordered prior to surgery.

How to Prepare

It's important to talk to your healthcare provider about what you can expect in terms of the look of your breasts after surgery. This cannot only ensure that you have realistic expectations, but it can help shape your overall surgical plan.

Prior to your capsulectomy, your surgeon will give you instructions on how to best prepare.

Location

A capsulectomy is performed in a hospital or surgical center by a plastic surgeon.

What to Wear

You will change into a hospital gown upon arriving. As such, it's best to wear clothes that are easy to remove on the day of your surgery.

Do not wear makeup, hairspray, cream, lotion, or perfume. Leave all jewelry (including body piercings) and valuables at home.

Food and Drink

Avoid eating or drinking anything after midnight on the eve of your surgery.

Medications

Stop taking certain medications, like non-steroidal anti-inflammatory drugs (NSAIDs), and certain vitamins/herbal products 10 days prior to surgery.

Inform your surgical team of everything you take, including prescription and over-the-counter medications, herbal products, dietary supplements, vitamins, and recreational drugs.

What to Bring

You will need to wear a support bra with a front closure after your surgery. This bra may be provided to you by the surgeon, or you may be asked to purchase it on your own in advance.

If the latter, be sure to bring it with you on the day of your surgery. Also bring:

  • Your driver's license and insurance card
  • List of your medications
  • Comfortable clothes to go home in, including a blouse that can be buttoned or zipped in the front
  • Slip-on shoes to go home in (to avoid having to bend over)

If you are staying overnight in the hospital or in a recovery care center, be sure to also bring:

  • Personal items (e.g., toothbrush, hairbrush, robe)
  • Comfort and practical items (e.g., hand cream, book, phone charger)
  • Medical devices, if applicable (e.g., inhaler or eyeglasses)

Once discharged, you will need to arrange for someone to drive you home. You will also need to have someone stay with you the first day after your surgery.

Pre-Op Lifestyle Changes

Your surgeon will ask you to stop smoking at least six weeks prior to surgery. Smoking can delay the healing process and have a significant negative effect on anesthesia.

What to Expect on the Day of Surgery

On the day of your operation, you will arrive, check-in, and show your driver's license and insurance card.

After checking in, you will be taken to a holding area where you be led into a small pre-operative room.

Before the Surgery

Here, you will change into a hospital gown and stow your belongings.

A surgical nurse will review your medication list, record your vital signs, and place an intravenous (IV) line into a vein in your arm.

You may receive an antibiotic through the IV at this time to help prevent postoperative infection. This IV will also be used for administering fluids and medications during and after surgery.

Your surgeon and anesthesiologist will then come to greet you and review the operation with you. You may need to sign one or more consent forms at this time.

Besides citing the overall risks of surgery, one of the required consent forms will review the possibility of unsatisfactory results after surgery (e.g., unanticipated breast shape/size if implants are removed and/or replaced).

From there, you will walk on your own into the operating room or be wheeled on a gurney.

During the Surgery

In the operating room, the anesthesiologist will give you inhaled or intravenous medication to render you temporarily unconscious. You will not remember or feel anything during surgery.

Once you are asleep, the anesthesiologist will insert a breathing (endotracheal) tube down your throat to help control your breathing during surgery.

Your surgery will take around two to three hours and proceed in this general fashion:

1. Incision

The surgeon uses a scalpel to make one or more cuts within the breast (e.g., along the breast crease, which is the area where the breast meets the chest).

2. Removal

The specifics of this step depend on the type of procedure being done:

  • Partial or total capsulectomy with implant removal: Tissue surrounding the capsule is cut away. An incision is then made in the capsule through which the implant will be removed. Next, the capsule is partially or totally removed in one or more larger sections.
  • En bloc capsulectomy: The capsule is surgically separated from surrounding tissues (while still containing the breast implant). The whole unit (capsule + implant) is removed through the incision.

3. Implant Replacement

An implant is usually replaced at this point in the procedure.

Depending on your case, your surgeon may also choose to place acellular dermal matrix (ADM)— a special type of surgical mesh made from human or animal skin.

It would be placed within the pocket surrounding the implant as its being replaced to help reduce the incidence of capsular contracture.

4. Final Steps

The capsulectomy itself is now done. Your healthcare provider will finish up the surgery by:

  • Placing drains: In some instances, like if ADM is used, drains may need to be placed underneath the skin temporarily.
  • Closing the incisions: Sutures or skin adhesives are used to close the surgical cuts.
  • Sending material to pathology: The removed capsule (and implant) may be sent off to a laboratory to be examined under a microscope.

Finally, anesthesia will be stopped and the breathing tube will be taken out.

You will then be wheeled to a recovery area.

After the Surgery

You will slowly wake up from anesthesia while in the recovery area. You may feel drowsy, nauseated, and sore.

Your nurse will monitor your vital signs and administer medication as needed to help you feel more comfortable.

If you are being discharged that day, it will likely be a few hours after the procedure. If not, you will be moved to a hospital room for your overnight stay once the surgical staff deems you are ready.

Recovery

Recovery times for this surgery vary, depending on the type of capsulectomy performed, the extent of the procedure, and whether/how your implants are replaced.

That said, generally speaking, recovery from capsulectomy takes around four to six weeks.

During this timeframe, expect to experience breast pain, swelling, and bruising. Breast numbness or unusual nerve sensations like tingling or burning are also common and normal.

To soothe any discomfort, take your pain medication as prescribed. Your surgeon may also recommend gentle breast massage to help ease nerve sensitivity.

You may also be asked to sleep on your back for a certain period of time to minimize swelling and optimize wound healing.

Wear your support bra as directed.

Showering

Most patients can shower 24 to 72 hours after their operation, but follow your healthcare provider's specific instructions.

Also confirm with your surgeon whether you can remove your bra temporarily to shower. If you can, wash the incision sites gently and pat them dry with a clean towel.

If you have adhesive strips covering the incision sites, leave them in place.

Avoid soaking in a tub until your sutures/drains have been removed, and you have been given the OK by your surgeon.

When to Call the Healthcare Provider

Call your healthcare provider right away if you experience:

  • Fever or chills
  • Signs of a breast infection or bleeding, such as severe breast swelling or bruising
  • Worsening or significant pain that is not relieved with medication
  • Signs of a wound infection including swelling, redness, warmth, bleeding, or foul-smelling drainage from the incision site(s)
  • Reaction to any medication (e.g., rash, headache, nausea/vomiting, or constipation)
  • Calf pain or chest pain
  • Trouble breathing

Diet

In terms of eating, your surgeon may advise you to avoid salt and caffeine for two weeks after the surgery. Salt can worsen swelling, and caffeine made impair blood flow to your wound sites.

Since you may experience some nausea from the pain medication and/or have a decreased appetite after surgery, it's sensible to stick with bland foods that are easy to prepare and eat for the first week or so after your operation.

Some suggestions include pudding, oatmeal, bananas, and pasta.

Physical Activity

While your surgeon will want you to take it easy for the first week or so after surgery, it's important to start taking short walks as soon as possible. Walking can help expedite healing and prevent complications like blood clots.

Your surgeon will also ask you to avoid strenuous/vigorous activities and heavy lifting for at least a month. In some cases, you may be asked to avoid certain movements for a designated period of time. Examples include elevating your arms, twisting, reaching, and bending over.

Within a month, and once you are off all prescription pain medications, you should be able to drive.

If you work outside of the home, talk to your surgeon about when you can return to your job. The timeline will vary depending on your job's physical demands, and how well you are recovering.

Follow-Up

Expect to see your surgeon a few days after surgery, especially if you had drain(s) placed. At this appointment, your surgeon will remove any drains, check your incision sites, and monitor for complications.

Any non-absorbable sutures will be removed and your healing will continue to be monitored at additional follow-up visits.

Long-Term Care

The final results of your surgery depend on the type of capsulectomy you underwent, whether you had implants replaced, and the quality and amount of breast tissue that is left.

Full results may not be seen for up to a year.

Keep in mind that while your post-surgical scars will improve on their own over time, they will darken and take longer to fade if exposed to sunlight. Therefore, it's important to remain diligent about applying sunscreen.

If you are concerned about scarring, talk with your surgeon. Once your wounds have closed and fully healed, your surgeon may recommend massaging petroleum jelly or a lubricating moisturizer over the scars twice daily for 10 minutes.

Finally, if you had implants placed, you will need to undergo regular breast MRIs starting three years after surgery and then every two years thereafter.

Diagnosis of BIA-ACLC

After a capsulectomy for BIA-ACLC, most patients do not need to undergo any further treatment. That said, patients with advanced disease may need to undergo chemotherapy after surgery. All patients with BIA-ACLC must undergo cancer surveillance every three to six months for at least two years.

Possible Future Surgeries

If you undergo a capsulectomy with breast implant replacement, a future surgery will be needed at some point, as breast implants are not meant to last forever.

Future revisional surgeries may also be desired if you are not satisfied with how your breasts look after surgery. Depending on your case, your surgeon may recommend a breast lift and/or replacing your implants with a different type or size.

A Word From Verywell

As you continue to learn more about this surgery, remain an advocate for your care. Do not hesitate to seek out more than one opinion from a board-certified plastic surgeon.

You may also consider asking your surgeon to put you in touch with other women who have had a capsulectomy and are willing to share their experiences.

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